open access

Vol 91, No 8 (2020)
ORIGINAL PAPERS Gynecology
Published online: 2020-08-31
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Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

İbrahim Ferhat Urunsak, Ghanim Khatib, Mehmet Ali Vardar, Ahmet Baris Guzel, Umran Kucukgoz-Gulec, Sevtap Seyfettinoğlu
DOI: 10.5603/GP.2020.0077
·
Pubmed: 32902842
·
Ginekol Pol 2020;91(8):453-459.

open access

Vol 91, No 8 (2020)
ORIGINAL PAPERS Gynecology
Published online: 2020-08-31

Abstract

Objectives: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population.

Material and methods: Endometrial cancer patients’ archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not.

Results: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively).

Conclusions: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients.

Abstract

Objectives: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population.

Material and methods: Endometrial cancer patients’ archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not.

Results: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively).

Conclusions: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients.

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Keywords

laparoscopic surgery; lymphadenectomy; morbid obesity; endometrial cancer; oncologic outcomes

About this article
Title

Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

Journal

Ginekologia Polska

Issue

Vol 91, No 8 (2020)

Pages

453-459

Published online

2020-08-31

DOI

10.5603/GP.2020.0077

Pubmed

32902842

Bibliographic record

Ginekol Pol 2020;91(8):453-459.

Keywords

laparoscopic surgery
lymphadenectomy
morbid obesity
endometrial cancer
oncologic outcomes

Authors

İbrahim Ferhat Urunsak
Ghanim Khatib
Mehmet Ali Vardar
Ahmet Baris Guzel
Umran Kucukgoz-Gulec
Sevtap Seyfettinoğlu

References (18)
  1. Managing and Preventing Obesity. 2015.
  2. Arem H, Irwin ML. Obesity and endometrial cancer survival: a systematic review. Int J Obes (Lond). 2013; 37(5): 634–639.
  3. Pavelka JC, Ben-Shachar I, Fowler JM, et al. Morbid obesity and endometrial cancer: surgical, clinical, and pathologic outcomes in surgically managed patients. Gynecol Oncol. 2004; 95(3): 588–592.
  4. von Gruenigen VE, Tian C, Frasure H, et al. Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma : a Gynecologic Oncology Group study. Cancer. 2006; 107(12): 2786–2791.
  5. Bouwman F, Smits A, Lopes A, et al. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature. Gynecol Oncol. 2015; 139(2): 369–376.
  6. Zullo F, Falbo A, Palomba S. Safety of laparoscopy vs laparotomy in the surgical staging of endometrial cancer: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol. 2012; 207(2): 94–100.
  7. Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol. 2012; 30(7): 695–700.
  8. Vardar M, Gulec U, Guzel A, et al. Laparoscopic surgery for low, intermediate and high-risk endometrial cancer. Journal of Gynecologic Oncology. 2019; 30(2).
  9. Frost JA, Webster KE, Bryant A, et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2015; 10(9): CD007585.
  10. Rungruang B, Olawaiye AB. Comprehensive surgical staging for endometrial cancer. Rev Obstet Gynecol. 2012; 5(1): 28–34.
  11. Kumar S, Mariani A, Bakkum-Gamez JN, et al. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013; 130(3): 441–445.
  12. Gunderson CC, Java J, Moore KN, et al. The impact of obesity on surgical staging, complications, and survival with uterine cancer: a Gynecologic Oncology Group LAP2 ancillary data study. Gynecol Oncol. 2014; 133(1): 23–27.
  13. Mendivil AA, Rettenmaier MA, Abaid LN, et al. A comparison of open surgery, robotic-assisted surgery and conventional laparoscopic surgery in the treatment of morbidly obese endometrial cancer patients. JSLS. 2015; 19(1): e2014.00001.
  14. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer. 2016; 26(1): 2–30.
  15. Scaletta G, Dinoi G, Capozzi V, et al. Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review. European Journal of Surgical Oncology. 2020; 46(5): 782–788.
  16. Cheng Z, He X, Zhao A, et al. Early endometrial carcinoma therapy in morbid obesity: A retrospective study comparing open and laparoscopic. Int J Surg. 2016; 30: 31–34.
  17. Fornalik H, Zore T, Fornalik N, et al. Can Teamwork and High-Volume Experience Overcome Challenges of Lymphadenectomy in Morbidly Obese Patients (Body Mass Index of 40 kg/m2 or Greater) with Endometrial Cancer?: A Cohort Study of Robotics and Laparotomy and Review of Literature. Int J Gynecol Cancer. 2018; 28(5): 959–966.
  18. Chan JK, Gardner AB, Taylor K, et al. Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients - a comparative analysis of total charges and complication rates. Gynecol Oncol. 2015; 139(2): 300–305.

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